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Immediate Suppression of Lactation

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IMMEDIATE SUPPRESSION OF LACTATION POLICY BC Women’s Hospital and Health Centre is a World Health Organization (WHO) recognized breast- feeding and ‘baby-friendly’ hospital. There are however circumstances when avoidance of breastfeeding is necessary and suppression of lactation is desirable. Breastfeeding is contraindicated for infants born to HIV positive mothers irrespective of maternal antiretroviral therapy and viral load. HIV positive women should be supported when using alternate feeding methods for their infants. Women with stillbirth or second trimester termination may wish to offer their breast milk to the milk bank or to suppress their lactation. Women taking medications contraindicated in breastfeeding. Appropriate treatment should be provided to manage potential pain and engorgement in non- breastfeeding women until lactation ceases. All non-breastfeeding women should be offered pharmacological methods of lactation suppression. Applicability: Care of a woman who requires immediate suppression of lactation occurs in the Acute Perinatal Program. PROCEDURE 1.1 Immediate Suppression of Lactation after Birth There is insufficient evidence to recommend one single form of non-pharmacological or pharmacological treatment. Non-pharmacologic Strategies o Avoid unnecessary breast stimulation. o Wear a firm supportive bra or top. o Apply external agents (cool cloths, ice packs, washed cabbage leaves). Pharmacological Strategies o Advise the woman regarding the options for analgesia (e.g., acetaminophen, NSAIDS if not contraindicated). o Advise the woman regarding the option of using cabergoline for the prevention of lactation, including its role and potential side effects. 1.2 Cabergoline Summary Dopamine ergoline derivative which directly stimulates D2 receptors on pituitary lactotrophs to inhibit prolactin secretion. Moderately protein bound (41%) with long elimination half-life (63-69 hours). Metabolized by hydrolysis into inactive metabolites; no involvement of CYP-P450 enzyme system. 1 mg (2 x 0.5 mg tablet) orally on Give with food to improve tolerability the first postpartum day No dose reduction required for mild or DOSAGE (may be given up to 2-3 days post- moderate hepatic or renal insufficiency partum; most effective on first postpartum day) Headache, Fatigue, Dizziness, Maximal hypotensive effect occurs < ADVERSE EVENTS Nausea, Orthostatic hypotension 6hrs after drug intake Hypersensitivity to cabergoline or any ergot derivative CONTRA-INDICATIONS Hypertensive disorders in pregnancy WW.06.07O Fetal Maternal Newborn and Family Health Policy and Procedure Manual Effective Date: 27-OCT-2015 Page 1 of 2 IMMEDIATE SUPPRESSION OF LACTATION Postpartum hypertension and receiving anti-hypertensives Pulmonary or cardiac fibrotic disorders Cardiac valvulopathy Hypotension Raynaud’s syndrome PRECAUTIONS History of psychosis Gastrointestinal bleeding Dopamine antagonists (e.g., Co-administration may reduce prolactin metoclopramide, phenothiazines) lowering effect of cabergoline ▪ Ergot alkaloids (e.g., ergometrine) Theoretical additive toxicity with ergot alkaloids; no documented interaction DRUG INTERACTIONS documented ▪ Macrolide antibiotics (e.g., Pharmacokinetic study reported Erythromycin / Clarithromycin) increased clarithromycin levels; no documented clinical adverse effects DOCUMENTATION Prescriber’s Orders Medication Administration Record REFERENCES 1. Money D, Tulloch K, Boucoiran I et al. Guidelines for the care of pregnant women living with HIV and interventions to reduce perinatal transmission. J Obstet Gynaecol Can 2014;36(8):721-51. 2. Oladapo OT et al. Treatments for suppression of lactation (review). Cochrane Database of Systemic Reviews 2009, Issue 1 3. Dostinex® Product Monograph, Kirkland, Quebec: Pfizer Canada Inc. July 2013 APPENDIX Appendix 1: Literature Summary for Lactation Suppression Treatment for Post-Partum Women (WW.06.07P) WW.06.07O Fetal Maternal Newborn and Family Health Policy and Procedure Manual Effective Date: 27-OCT-2015 Page 2 of 2 .
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